Articles: intubation.
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An exercise in quality assurance during neuroanaesthetic procedures identified uncontrolled re-use of armoured latex rubber tracheal tubes as a risk factor associated with equipment failure. We recommend that such tubes should be used once only. Alternatively, tubes made from more stable materials, such as polyvinyl chloride and silicone rubber, are available for clinical evaluation.
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Real-time B-mode ultrasound imaging was performed in 24 intubated patients in order to confirm the correct placement of endotracheal tubes. The large acoustic impedance mismatch between the air within the endotracheal tube cuff and the tracheal wall could be bypassed by (1) use of a foam-cuffed Bivona endotracheal tube, or by (2) cuff inflation with saline instead of air. Optimal repositioning of the endotracheal tube could be done under direct visualization. ⋯ Use of a noninvasive imaging modality such as ultrasound will spare selected patients from the radiation exposure associated with a chest x-ray. This is of value in pregnant patients and in those requiring frequent chest radiographs for the sole purpose of confirming correct endotracheal tube placement. Limitations of the techniques are discussed.
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Acta Anaesthesiol Scand · Aug 1987
Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation.
Laryngoscopy and endotracheal intubation cause a stress reaction resulting in an increase in heart rate and systemic blood pressure. This haemodynamic response is considered to be due to a sympathetic discharge caused by stimulation of the upper respiratory tract. This stress reaction during laryngoscopy and endotracheal intubation was studied in patients with total thoracolumbar epidural anaesthesia (EDA). ⋯ The epidural anaesthesia caused a reduction of the mean arterial blood pressure (MAP) by 25%, and a reduction of the heart rate (HR) by 7%, but neither the induction with thiopentone nor the laryngoscopy and intubation caused any changes in mean arterial blood pressure or heart rate. However, in the control group MAP increased 29% and HR 16% following intubation. Thus, the T1-L2 epidural anaesthesia with 2% mepivacaine with adrenaline blocked the blood pressure reaction to laryngoscopy and intubation, and consequently the efferent sympathetic nervous system was completely blocked.
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Endotracheal tube (ETT) fire has been reported secondary to laser and electrocautery ignition. The flammability of polyvinylchloride (PVC), silicone (Si), and red rubber (RR) ETTs in oxygen (O2) and/or nitrous oxide (N2O) in nitrogen was determined and compared by means of the O2 and N2O indices of flammability. The O2 index of flammability is the minimum O2 fraction in nitrogen that will support candle-like flame using a standard ignition source. ⋯ Flammability is a valid method of comparing safety of various endotracheal tube materials. There is a need for new endotracheal tube material with a higher index of flammability. The significance of these findings and the clinical applications are discussed.